Course: Patient Safety and Medical Errors

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Assignments

» Midterm Assignment (30% of overall grade)

For this assignment, students will review the case of an adverse event - the story of Brianna Cohen from the Baltimore Sun.

  1. Briefly describe the incident in 1 page or less.
  2. Describe the points at which failures occurred.
  3. Identify the factors at various levels of the system that contributed to those failures.

Students are encouraged to use the "Investigating a defect" tool described in Dr. Pronovost's lecture and reading (PDF).

Grading Scheme

  1. Description of problem = 20 points
  2. Identification of the points at which failure occurred = 20 points
  3. Contributing factors = 40 points (5 points for identifying possible/probable factors at each of the following levels: patient/family, task, individual provider, team, training and education, information technology, local environment, institutional environment)
  4. Reasoning and clarity of presentation = 20 points

» Final Paper Topic Submission (5% of overall grade)

Option 1: Patient Safety Quality Improvement Proposal

Describe an important patient safety problem you propose to address in a particular health care setting or organization (i.e. ABC hospital, XYZ clinic). Develop a proposal for the implementation and evaluation of a quality improvement intervention that is appropriate to address the problem and feasible for the selected health care setting.

Option 2: Literature Review of Patient Safety Problem and Solutions/Interventions

Conduct a review of the scientific literature on a documented patient safety issue/problem and potential solutions/interventions that have been identified and evaluated. Discuss the feasibility, appropriateness and evidence that supports the effectiveness of these solutions/interventions to address the problem.

» Final Paper (55% of overall grade)

The final paper will be graded on the basis of 100 possible points which will be allocated according to the following criteria for each paper option.

Option 1. Patient Safety Quality Improvement Proposal

  1. Demonstrates strong understanding of relevant patient safety issues/problem = 20 points
  2. Appropriate use of literature to support arguments/claims and appropriateness of the selected quality improvement = 20 points
  3. Detailed description of implementation of the quality improvement, with concern for feasibility and organizational barriers = 20 points
  4. Strong plan for the evaluation/assessment of the effectiveness of the quality improvement = 20 points
  5. Clear, logical, and fully developed discussion/arguments = 10 points
  6. Solid presentation (use of proper grammar, adheres to page limit, cites references appropriately) = 10 points

Option 2. Literature Review of Patient Safety Problem and Solutions/Interventions

  1. Demonstrates strong understanding from the literature of relevant patient safety issues/problem, including magnitude and impact of the problem, and contributing factors = 50 points
  2. Literature supports argument on the appropriateness of the potential solutions/interventions = 10 points
  3. Well-argued discussion on feasibility of potential solutions/interventions = 10 points
  4. Makes good use of evidence and data on the effectiveness of the potential solutions = 10 points
  5. Clear, logical, and fully developed discussion/arguments = 10 points
  6. Solid presentation (use of proper grammar, adheres to page limit, cites references appropriately) = 10 points